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November 1st, 2018

As a child growing up in Taiwan, Angela Chao didn’t like to brush her teeth. Oral hygiene in her community was not a big priority, and her parents “had more challenges to face than my stubborn hatred for the spicy mint of toothpaste.”

The result, of course, is that Chao developed many cavities as a middle schooler. A fear of doctors made her hesitant to visit the dentist, though she eventually did get fillings. But several years later, after moving to the United States, those fillings failed and her teeth began breaking apart.

Still wary of the dentist, “it wasn’t until the pain stopped me from eating and smiling and caused me to avoid social interaction that I decided to do something,” she said.

Chao went to Gentle Dental Associates in Ann Arbor for a consultation and was advised to get a dental implant. Skeptical at first, she did her own research on implants and other options for replacing missing teeth, then talked with other people who had gotten implants.

She decided to go through with the procedure.

“I told myself that if I don't do it now, then when?” said Chao, now in her 50s. “Getting an implant was an easy choice for me over other options.”

Chao is like 170 million other adults in America who are missing teeth. Half of adults age 20-64 are missing at least one permanent tooth, according to the latest national survey data from the National Health and Nutrition Examination Survey.

While a majority of people age 20-39 still have a full set of teeth, only one of every three people age 40-64 do. The primary causes of tooth loss include cavities and periodontal disease, which both stem from poor oral hygiene and lack of consistent dental care.

A missing tooth can cause several problems.

“If a tooth is missing, then chewing becomes less efficient and the neighboring teeth alongside the space may be subject to over-function and eventual fracture,” said Dr. Debby Hwang, a periodontist at Gentle Dental Associates. “An absent front tooth also may hinder cosmetics and speech.

“Replacing a tooth can protect the remaining teeth, allow for normal eating and digestion, restore any speaking deficits and contribute to psychological health.”

There are three options for replacing a missing tooth:

A removable denture is a cost-effective choice, but it needs to be taken out every night and is relatively fragile, so it might not provide full chewing function. Chao preferred to have a permanent replacement instead of something removable.

A fixed bridge fuses a fake tooth to adjacent teeth and is not removable. The neighboring teeth get crowns that are fused to a fake tooth in the middle. Chao wanted to avoid cutting into her healthy, natural teeth to support a bridge.

A dental implant involves a titanium anchor that’s placed into the bone where the tooth is missing. The jaw bone grows around the anchor, which is then capped with a crown several months later. It’s like having your own tooth back.

An implant is typically a long-term solution that, unlike the other options, does not rely on neighboring teeth for support and cannot decay, Hwang said. Plus, many people are surprised by the lack of discomfort they experienced during and after the procedure.

A dental implant is the most-costly option to replace a missing tooth, at least initially. But because it doesn’t decay or break it often can be the most cost-effective solution over the long term. If something breaks in a bridge, for example, you have to replace all three teeth. It’s also more likely to get cavities with a bridge because you can’t floss in between those teeth.

Because a dental implant is fixed into the jaw, it can be a “high-value, high-return choice,” Hwang said.

Chao was able to afford dental implants because her family had put aside money to pay for health care costs. If you have a Health Savings Account through your employer, that can be a great way to cover the cost.

Many employers also allow people to put money into a flexible spending account (FSA) for health care, and that “use-it-or-lose-it” money has to be spent by the end of the year or it’s gone. If you have an FSA, that can be a good way to pay for implants before the end of 2018 — or a good place to put money in 2019 to pay for implants next year.

The reward of being able to smile and laugh and eat with ease again has been well worth the cost to Chao.

“I don’t have to worry about my smile anymore,” she said. “Chewing food is becoming easier and my posture and my facial features are slowing coming back in balance since I had my implants done. I am very happy!”

October 1st, 2018

Dreading the dentist ranks right up there with being scared of snakes and afraid of heights as the biggest fears of Americans. Now, a new study finds that fear of the dentist has a clear, negative impact of people’s oral health.

One of every eight people has dental phobia, and they are more likely to have decayed or missing teeth, the study concludes. People scared of the dentist also tend to have more negative feelings like sadness, tiredness and lethargy, lead author Dr. Ellie Heidari said.

“This phobia can have a major impact on a person’s quality of life,” she said. “An action as simple as smiling will be avoided due to embarrassment of their poor teeth.”

While extreme dental anxiety is relatively rare, as many as 80 percent of Americans are at least a little afraid of going to the dentist. Unfortunately, that fear hinders people’s oral health because they put off regular teeth cleanings. Nearly a quarter of people who suffer from some level of dental anxiety do not get regular dental treatment, and upwards of 10 percent avoid going to the dentist entirely.

That’s a problem because “regular dental attendance is central for maintenance of oral health as well as avoiding dental pain,” Heidari said.

So what can be done about dental anxiety? First, let’s look at some of the causes. People worry about going to the dentist for any number of reasons: maybe they had a painful experience in the past, or maybe they’re scared by the sadistic, drill-happy dentist stereotype portrayed in movies. For some people the cost of dental care can give them pause, and for others it might be embarrassment about the health of their teeth.

“Another one is fear of the unknown,” said Dr. Neha Kuthiala, DDS, a dentist at Gentle Dental Associates, an Ann Arbor practice that offers free consultations. “It’s a situation where you’re asked to sit with your mouth open and you can hear things and feel things but you have no idea what is being done to you.

“Dental work is not something people want to have done. It’s just one of those things.”

But whether you want to get dental work or not, going to the dentist is vital for your oral health. And there’s no reason a trip to the dentist can’t be pleasant. In fact, here are three ways to make seeing a dentist a smooth, stress-free experience:

*Get preventative care before it’s too late — It’s better to fill a cavity than to wait and have to remove the tooth later. “The thing with avoiding the dentist or waiting until you have pain is that a lot of times by that point you need something that costs more than preventative care would have,” Kuthiala said. “Coming in for a preventative cleaning tends to save you in the long run.”

*Commit to consistent home care — You may not have to floss every single day (although that’s not a bad idea), but you should do it more than once a month. The better you follow the advice of your dentist and hygienist, the better results you’ll have when you go in for a checkup. “A lot of people are feeling very judged on their oral hygiene and any existing cavities or anything that might be diagnosed at the dental office,” Kuthiala said. “As long as patients are doing their part at home and cleaning to their best of their ability, that’s all they can do.”

*Talk with your dentist about your anxiety — Share what you’re worried about. At the same time, a good dentist will take time to talk with anxious patients before looking into their mouths. “If we know the reason for anxiety, a lot of the time we can work with the patient to alleviate that,” Kuthiala said.

The dentist can have a big impact on your level of anxiety simply by treating patients as people rather than procedures. That can include keeping patients up to speed on the progress of a procedure and talking about what they’re doing each step of the way, or giving patients control by allowing them to stop a procedure any time they feel uncomfortable.

In addition, scheduling patients with the same hygienist and dentist every visit is a proven way to ease anxiety. Also, distractions like office music or a TV in the operating room can take people’s minds off their fear.

Of course, providing nitrous oxide, or laughing gas, can be a good option for some anxious patients, too.

“We’re all aware of how people don’t like to come to the dentist,” Kuthiala said. “We try our best to treat them with a gentle touch.

“There’s much more to that person than just whatever it is that you’re working on (in their mouth). We want to treat patients as the person, not just the tooth.”

September 4th, 2018

Jean McClain-Moutardier knew her 9-year-old daughter needed some work done on her teeth. But since she didn’t have dental insurance to help cover the cost, she didn’t bring her in right away

Doing the paperwork to get coverage took time. Too much time, in this case.

On a Saturday night a few weeks ago, the girl kept waking up in horrible pain. McClain-Moutardier wasn’t going to wait any longer. She took her daughter to the Emergency Room for pain relief, and then to a follow-up appointment with a dentist.

She found out the routine dental care the girl needed had progressed into a serious problem requiring major repairs.

“At the point that she got to, I really didn’t care what had to be done,” McClain-Moutardier said. “No one likes to see their kid in pain.”

Many people are scared of going to the dentist. Others may have a hard time fitting an appointment into their schedule, and in some places it’s not easy to find a dentist’s office. But, by far, the biggest obstacle to getting regular dental care is cost.

Most people believe that visiting the dentist is important. Yet, nearly 60 percent of people who skipped routine dental care in the past 12 months said they couldn’t afford it, according to an American Dental Association poll.

“Cost was the main reason irrespective of age, income level or dental insurance status,” researchers wrote about the survey in the Health Affairs journal. “It is important to note that cost was the top barrier to dental care even for adults with private dental insurance.”

So, what’s the problem with avoiding the dentist? Well, just like an untreated problem with an automobile, problems with teeth get worse over time. In the long run, semi-annual dental cleanings cost much, much less than tooth extractions, crowns and root canals that can cost thousands of dollars.

And it’s not just teeth that suffer when dental care is ignored. A growing body of research links poor oral health to several health problems including cardiovascular disease, respiratory infections and dementia.

Studies have shown that people who see the dentist regularly have fewer health issues and spend less money on medical care overall.

“There is compelling evidence that financial barriers to dental care result in serious consequences to oral health and overall health and well-being,” researchers wrote. “Adults are suffering serious consequences from not receiving dental care because of cost.”

The survey data is helpful for public policy makers looking to improve the country’s health. On an individual level, the data makes it clear that private dental practices must do more to make routine care affordable to patients.

Some dentist’s offices now offer discount plans to help patients pay for regular cleanings and avoid the much-higher costs of major restorative care. For example, Gentle Dental Associates in Ann Arbor offers a preventive care package that includes two semi-annual exams, two professional cleanings and one set of bitewing X-rays for the low cost of just $22.50 per month.

Or, for a small annual fee, Gentle Dental Associates covers the entire family with 35-percent off preventive services such as exams, cleanings and X-rays, and 25-percent off restorative services such as fillings, crowns, root canals and implants.

“We created these plans in response to patients that only came when they were in pain and had to have a tooth removed,” said Felicia Romberger, office manager. “We wished they would come for regular cleanings so that they didn’t have to suffer the catastrophic consequences of lost teeth.

“The best way to save money on dental care is to have twice-annual preventive appointments. This allows problems to be diagnosed quickly and treated before they become more intrusive and expensive.”

Here’s a quick cost comparison:

A small one-surface filling costs between $150 and $200

If that cavity is not treated until it progresses and becomes painful, then a root canal, core and crown could be needed at a cost of about $3,000

Even the cost of extracting the tooth would be about $100 more than filling the cavity early, and removing a tooth can lead to other problems: difficulty chewing, increased risk of bone loss and higher likelihood of additional extractions.

About 60 percent of adults go to the dentist regularly, according to survey data. But many people put off visiting the dentist until something is wrong, and that’s when care becomes more expensive.

The U.S. Centers for Disease Control estimates that 27 percent of adults have an untreated cavity. This can be fixed with a simple filling, but if the cavity festers and expands it will require dental care that can cost 15 to 20 times as much money.

“All of this could be prevented if it was caught early, and a filling costs less than an extraction, too,” Romberger said. “Plus, there is little to no pain involved with a filling.

“We have had great success in helping those patients without insurance remain healthy with our affordable plans.”

Ironically, putting off visits to the dentist because of cost actually ends up costing more in the long run. It was an expensive lesson learned for McClain-Moutardier. Her daughter had to have a pulpotomy on one of her molar teeth, and she’ll eventually need a full root canal, too.

Worse than that, she feels horrible that her daughter had to go through such a painful experience.

“Thinking no one’s going to be able to help me because I don’t have insurance is not the right way to look at it,” McClain-Moutardier said. “I should have not been afraid to ask for help and do what I needed to do to fix the problem before it became a big problem.”

Behind cost, fear of the dentist was the second-biggest reason people avoid going to the dentist, according to the ADA survey. Other leading reasons: people say their appointment time and location are inconvenient, have trouble finding a dentist, or no longer have any teeth.

May 24th, 2017

Inflamed gums are a fairly common dental issue, but unfortunately, many people don't take the problem seriously enough. If you ignore inflamed gums and continue your usual routine, you could be encouraging a much more severe inflammation problem, and the pain that goes along with that. Fortunately, it is quite easy to relieve inflamed gums if you use the tips below.

Use Soft Bristles

A soft-bristle toothbrush - the softest you can buy - is a must for anyone with inflamed gums. Anything that makes contact with your gums can cause you pain, so fine and soft bristles are always the best choice.

Use Sensitive Formula Toothpaste

The toothpaste marketed as “Sensitive Teeth Formula” contain special ingredients to help relieve sensitivity. When your gums are inflamed, even light brushing can cause some pain. Using a special toothpaste will help reduce that pain and make it easier to brush your teeth effectively. The effect becomes stronger as you use the toothpaste more, so use it for each brushing.

Visit Our Office

If your gums remain swollen for more than a few days or a week, set up an appointment with Dr. Tijen Lacin, Dr. Yan Wang, Dr. Debby Hwang, Dr. Alessandra Dagostin, Dr. Ronald Lechner, Dr. Young Kim, and Dr. Neha Kuthiala. There is a long list of conditions that could be causing your swollen gums, everything from gum disease to pregnancy, so you need to find out where your issue is coming from. Most of the time, Dr. Tijen Lacin, Dr. Yan Wang, Dr. Debby Hwang, Dr. Alessandra Dagostin, Dr. Ronald Lechner, Dr. Young Kim, and Dr. Neha Kuthiala can easily treat the swollen gum issue at our Ann Arbor, MI office, or can give you an effective treatment to take home.